When Couples Therapy Isn't Enough: A Therapist's Honest Take

Couples therapy has a good evidence base. Research on Emotionally Focused Therapy (EFT) consistently shows that 70–73% of couples treated with EFT no longer meet the criteria for relationship distress at the end of treatment. The Gottman Method has similarly strong data. When couples therapy works, it works well - and it works faster than most people expect.

But couples therapy is not appropriate for every situation, and it's not honest to pretend otherwise. Here are the situations where couples therapy is limited or contraindicated.

Active domestic violence. Conjoint therapy - both partners in the same room - is contraindicated when there is active physical violence or serious coercive control in the relationship. The power imbalance makes it unsafe for the lower-power partner to speak honestly, and techniques designed to increase vulnerability can increase risk. Individual safety planning takes priority.

When one partner has already decided to leave. Couples therapy requires genuine ambivalence - both partners willing to work toward the relationship. When one partner has privately decided to end the relationship and is attending therapy to delay telling the other person, the process is compromised. In these cases, I find it more useful to shift to 'discernment counseling' - a structured, brief process specifically designed for couples where one person is leaning out.

Untreated individual psychopathology. Severe untreated depression, active substance use, or untreated personality disorders can make couples therapy largely ineffective until those conditions are being treated individually. I'm not saying therapy can't happen in parallel - but without individual treatment, the conjoint work is often incomplete.

What does work: honesty, ambivalence, and a shared commitment to doing the between-session homework. The couples who do best in our office are not the ones who have the smallest problems - they're the ones who show up consistently, are honest even when it's uncomfortable, and practice the skills between sessions. Couples therapy is not something that happens to you. It's something you actively do.

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